Air temperature and thrombotic cardiovascular disease in England: case time series studies using whole-population electronic health records during 2020-2022
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Background
Hot and cold air temperatures have been associated with fatal thrombotic cardiovascular disease, but evidence for non-fatal outcomes and drivers of susceptibility remains limited. Given the lasting cardiovascular effects of COVID-19 and its potential interaction with temperature exposure, we examined the impact of air temperature on thrombotic cardiovascular disease, as well as effect modification by COVID-19 and person-level characteristics.
Methods
We conducted case time series studies using whole-population electronic health records in England (Jan 2020-Dec 2022), linked with small-area daily mean air temperature. We estimated cumulative short-term effects of temperature on arterial thrombotic events (AEs), venous thrombotic events (VEs), acute myocardial infarction (AMI), and ischaemic stroke (IS), using conditional Poisson regression with distributed lag non-linear models, including interactions with COVID-19 status and person-level characteristics.
Results
Among 49,080,575 individuals, we identified 604,655 AEs, 215,090 VEs, 275,390 AMIs, and 231,485 ISs. Hot temperatures (99th percentile 23.1°C vs median 10.8°C) were associated with higher VE risk over 21 days (incidence rate ratio [IRR] 1.33, 95% CI 1.21-1.47), particularly among older adults, those with pre-existing conditions, and individuals of Black ethnic group. Cold temperatures (1st percentile -0.7°C vs median) were associated with AMI over 14 days (IRR 1.13, 95% CI 1.05-1.21), especially among those aged ≥65 years. No associations were found for AEs or IS. Cold temperatures increased VE risk among individuals with COVID-19 in the prior 6 months (IRR 1.40, 95% CI 1.05- 1.86), but not others.
Conclusions
Susceptibility to temperature-related thrombotic events varies across population groups and may change following recent infectious disease, such as COVID-19.
